复方α-酮酸配伍低蛋白饮食对长期腹膜透析患者微炎症的影响及其与营养状态关系的随机对照研究

目的：观察复方α-酮酸配伍低蛋白饮食对长期持续性不卧床腹膜透析（continuous ambulatory peritoneal dialysis，CAPD）患者血浆炎症因子水平变化的影响及其与营养状态的关系。 方法：89例CAPD患者随机分为3组，完成随访且资料完整的共78例，其中复方。酮酸配伍低蛋白饮食组31例，低蛋白组26例，常规蛋白组21例。所检测的营养指标包括血清白蛋白（albumin，Alb）、前白蛋白（prealbumin，PA）、转铁蛋白（transferrin，TRF）、视黄醇结合蛋白（retinol—binding protein，RBP）、胆固醇（cholesterol，TC）、甘油三酯（triglycerides，TG）、血浆瘦素（1eptin）以及肱三头肌处皮褶厚度（triceps skinfold thickness，TSF）、上臂肌围（mid-arm muscle circumference，MAMC）和体质量指数（body mass index，BMI）；并检测血浆白细胞介素1α（interleukin-1α，IL-1α）、白细胞介素6（interleukin-6，IL-6）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）和C反应蛋白（C-reαctive protein，CRP）等炎症指标的变化。所有患者均随访1年。 结果：与低蛋白组相比，α-酮酸配伍低蛋白饮食组和常规蛋白组的营养指标升高，尤以PA、RBP和TRF升高明显（P＜0．01）；而α-酮酸配伍低蛋白饮食组与常规蛋白组相比，BMI、TSF、MAMC、Alb、TC及TG有升高趋势，但差异无统计学意义（P＞0．05）；α-酮酸配伍低蛋白饮食组血浆炎症因子IL-1α、IL-6、TNF-α和CRP等水平较常规蛋白组均有所下降，但仅CRP变化的差异有统计学意义（P＜0．01）。 结论：复方α-酮酸配伍低蛋白饮食不仅能有效地改善CAPD患者营养不良，而且可以改善CAPD患者体内微炎症状态。

Effects of low-protein diet plus a-keto acid on micro-inflammation and the relationship between micro-inflammation and nutritional status in patients performing continuous ambulatory peritoneal dialysis: a randomized controlled trial

OBJECTIVE: To investigate the effects of the combination of alpha-keto acid and low-protein diet on the levels of serum cytokines in patients performing continuous ambulatory peritoneal dialysis (CAPD) and to explore the relationship between inflammation and malnutrition in CAPD patients. METHODS: Eighty-nine CAPD patients were randomized into three groups, and 78 cases completed a one-year follow-up and with complete data. There were 31 cases in low-protein diet plus alpha-keto acid group, 26 cases in low-protein diet group and 21 cases in routine-protein diet group. The levels of serum albumin (Alb), prealbumin (PA), retinol-binding protein (RBP), transferrin (TRF), cholesterol (TC), triglycerides (TG), leptin, and triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), body mass index (BMI) were measured. The changes of serum interleukin-1alpha (IL-1alpha), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) were also detected. RESULTS: Compared with low-protein diet group, serum levels of PA, RBP and TRF were significantly increased both in low-protein diet plus alpha-keto acid and routine-protein diet groups ( P<0.01), however, there was no significant difference in the levels of PA, RBP and TRF between low-protein diet plus alpha-keto acid group and routine-protein diet group. There was an increased tendency in the content of Alb, TC, TG, BMI, TSF and MAMC, but there were no significant differences. The plasma levels of IL-1alpha, IL-6 and TNF-alpha in low-protein diet plus alpha-keto acid group were decreased as compared with the routine-protein diet group, but there were no significant differences. The plasma level of CRP in low-protein diet plus alpha-keto acid group was lower than that in the routine-protein diet group ( P<0.01). CONCLUSION: The combination of alpha-keto acid and low-protein diet can ameliorate malnutrition and micro-inflammation in CAPD patients.